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Great HbA1c, Very Disappointed!

CherryAA said:
One thing I have noticed...
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Very interesting, thank you. I certainly experienced what I'd call carb addiction when I was doing the carb-and-exercise thing, and really needed to increase the exercise to compensate for the carbs and calories. Which is okay for a non-diabetic but not for me; I could keep the exercise up daily in terms of energy levels, but not in terms of lifestyle.

I'm liley to need to go down the low carb route by the looks of things, so it's nice to hear that the occasional hit of carbs wouldn't be a distaster. I hope to get back into mountaineering next year, and just from a safety perspective, it would be nice to know I can be carrying a lot of fairly fast-acting energy with me! And so far that also seems to be a scenario where I can keep the spikes low, as I'll be using up energy shortly after the carbs.
 
ickihun said:
So your insulin resistance has improved as well. Hba1c doesn't cover that nor your fasting test.
So very very well done.
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Do you mean because it looks like the effect of exercise straight after carbs may be improving? I'm really hoping that will continue even if just at the level it is now. I'm hoping I haven't screwed up things with the carb-fest recently. After eating more sensibly for a few days, I'll be trying the carbs-then-exercise-straight-away thing again. I like the idea of using carbs for immediate fuel safely. I just need to pick carbs that don't taste too nice, so I only use them for fuel and don't get addicted again!
 

I posted the definition of remission below on another thread a few days ago. This is the best definition of remission that I have found. It introduces the time element, e.g. partial remission = 1 year, complete remission = 5 years. This is a marathon we are on, not a sprint. Success is measured in results over time. Any approach has to be sustainable, and low carb/eating to the meter is sustainable. That is the beauty of this approach.

Low carb is not a 8 week liquid diet, followed by a requirement to maintain great results for another mere 8 weeks to be considered "in remission" (that does look promising on paper, but it gives people the false hope that all that is needed is a short term fix, or diet if you will). No, to manage T2D our approach must be for life, and it must be sustainable. The low carb and BG monitoring approach ticks all the boxes for me, and 3 years in, it has been very sustainable!

Here is the definition from the 2009 position paper by Buse et al:

How Do We Define Cure of Diabetes?

“A remission can be characterized as partial or complete.
Partial remission is sub-diabetic hyperglycemia (A1C not diagnostic of diabetes [<6.5%], fasting glucose 100–125 mg/dl [5.6–6.9 mmol/l]) of at least 1 year's duration in the absence of active pharmacologic therapy or ongoing procedures.

Complete remission is a return to “normal” measures of glucose metabolism (A1C in the normal range, fasting glucose <100 mg/dl [5.6 mmol/l]) of at least 1 year's duration in the absence of active pharmacologic therapy or ongoing procedures.”

http://care.diabetesjournals.org/content/32/11/2133
 
I know how you feel.
I have a strategy. I'm only 1/3 the way through it. I can see the end thou.
I will not give up either. I do take time out to recharge my batteries. I'm heading in the right direction, as you.
So keep going, you are doing fantastic.
 

Whilst 7.8 is a good target to aim under at the 2 hour mark, much depends on where you start. If you start at 4, then it is not such a good level. I prefer to look at the actual rise, which should generally be under 2mmol/ and preferably less. It is also a good idea to test again at the 2.5hour mark, and again at the 3 hour mark when doing experiments.

My husband is definitely not diabetic, but he goes above 6.2 after a carb heavy meal.

When using exercise to lower levels, always be aware this will not always be physically possible so best not to rely on it.
 
You said your spikes are not as high.
Obviously your own insulin is able to work on your food more. More sensitive so less insulin resistant.

I normally do liver blocks to encourage my own insulin to cope with fatty protein nibbles before bed and on rising. The rising protein is lean as I want faster digestion through the day. Fat slows digestion down. So own insulin sorts out protein which gives slower conversion to energy but still energy. Own insulin can work better from not being strangled by carbs. Carbs are just a filler for me as too much protein I start getting higher bgs and the insulin therapy I'm on works better with some carbs. Reducing injected insulin units as I go. Hypos are my measuring stick of too much injected insulin.
I shouldn't get RH after bariatric surgery as I've prepared my body for less carbs. I'm guessing thou who end up RH after surgery have a heavy rush on insulin which is in keeping with insulin resistance.
I will be training my own insulin on coping with less for food before op. The liver shrinking diet is apparently full of carbs, for diabetics....oh lord! What a life. Lchf is the best liver detox, for me but no weight loss just healthier liver.

You do reduce your insulin resistance by exercising too. Which I cannot do. If I could I'd need far less insulin injected.
You are doing right to keep active and not start stressful overbearing exercise. Slow and steady....longterm fixes IR. Its not a quick fix.
Keep going.
 
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Insulin takers want less than 7.8 so they can reduce their insulin units. None-diabetic average 6.2 so sometimes higher, sometimes lower.
 
Biggles2 said:
This is the best definition of remission that I have found.
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I need to be very careful how I phrase this because it is likely to sound very disparaging of those guidelines, and I'm really not - if I ever achieve those standards then I will feel sure I've made improvements. I've clicked on 'informative' on your post because it is.

The thing I struggle with though is that surely it's possible to meet those guidelines by not eating carbs? So they are pretty good guidelines for letting you know you are doing the right thing, but they don't say much about whether or not you are diabetic.
 


I also struggle with those definitions. According to that, I have been in complete remission for 3 and a half years, but only due to my low carb diet. I doubt I could maintain it if I went back to "normal" food. I am not in remission. I am well controlled by diet.
 

Thank you for posting that link. I was aware of much of the content, but had not seen it so well summarized in one place before.
 
I was diagnosed in September with Type 2 (Hb1ac 64, fasting glucose 8.6. In addition, my cholesterol was 5.6 and triglycerides 7.6 - which is high, and largely due, I believe, unlike cholesterol, to carbs, not fats). I decided, rather than start on Metformin, to start Michael Mosely's Blood Sugar Diet, and three months on, I have Hb1ac of 32, fasting glucose 4.1, cholesterol 3.3 and triglycerides 1.6, all well within "normal" limits. I have also lost 3 stone in weight.

I am only too aware though that although this puts my diabetes in remission (providing the results are similar in another 3 months, my GP will add "resolved" to the diagnosis in my notes) but to keep it that way, and avoid a recurrence, and the associated risks, I will need to adopt this way of eating for the rest of my life. I can only say that while it is different, I find it in no way unpleasant, or a chore. I eat NO pasta, rice, bread, biscuits, cake, potatoes...but I do enjoy steak, plenty of fish, lots of veg, breakfasts with eggs, mushrooms, sometimes with celeriac or aubergine (fried egg on a celeriac rosti cooked with a little pancetta and shallot is MORE delicious than an egg on toast!). Despite my diagnosis being very recent, I already have retinopathy so I have no doubts whatsoever that returning to carbs would increase my risks of sight problems, limb loss and all the other nasty complications of later stage diabetes. At the end of the day, I'd rather do without toast than my feet. To me it's a no-brainer. I appreciate that some people have complex medical needs which might mean they can't do a low carb regime (what is low carb for some will be different for others - some try to go under 20 gms a day, but 50 seems a good "low" carb figure, and if you cut out all those obvious things (like bread, potato etc) that's easily sustained. Think of all the fabulous foods you CAN enjoy and think of bread as an arch enemy! Then you can forget about your eyesight getting worse or worrying whether your feet will suffer. They won't (anymore than any "normal" person's will). Ok, "normal" people can have the potatoes. You can't. But hey, there are worse things in life than (truly) low carbs!
 

Congratulations on the work you've put in and your results! I think your attitude about dealing with the required dietary changes is spot on.
 
Grateful said:
Thank you for posting that link. I was aware of much of the content, but had not seen it so well summarized in one place before.
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You're welcome. I really like that site. I've read various people describe her writing as bitter and scare mongering, but that's not the way it comes across to me. She seems disillusioned by mainstream medical practice and interested in the science, and writing up that science in an easy to digest way.
 

I disagree. The word "remission" in the dictionary sense only means "a diminution of the seriousness or intensity of disease or pain; a temporary recovery" (Websters). On that definition, the word is correct, particularly if you are using the first of those two definitions (the one before the semicolon).

To me it means, in the current context: One still has Type 2 diabetes, but (for one reason or another) it has been beaten back in such a way as to achieve a "recovery" of sorts. In your case (and mine) the method used is diet. I do not think of "remission" as being a particularly strong term, except when it is used in a religious sense!

Speaking for myself, I consider my T2D to be "well controlled," or "in remission," or "reversed." I think these are all reasonably accurate descriptions. What I do know for sure is that I am not "cured" and (barring a medical breakthrough in the future) I will not be "cured" in the future because the "reversal" depends entirely on diet. It is accurately described as a "chronic" disease.
 
I think some of the confusion may because certain words have a different context to Health Care Professionals.
"In remission" to an HCP can mean that all symptoms of the condition are no longer apparent with no medication being taken.
In effect, "Whatever you are doing is working so well I can't even tell that you have the disease. No need to waste your time on surgery visits. Go forth and sin no more.".
To us combatants down in the trenches, remission means that we no longer have the condition and don't have to take any special measures related to that condition.
Two very different views.

Apart from the Metformin, I think I am in "HCP remission" at the moment, and I am pretty sure I could hit the numbers without the Metformin. However there is enough indication of extra benefits from Metformin that I would prefer to keep taking it. I am, though, absolutely certain that I am still diabetic.

The bottom line is that with "normal" numbers the danger of health complications due to poor blood glucose control have been massively reduced and should be on a par with non-diabetics. So effectively in remission if not cured.

The potential hidden flaw is if some of the systemic damage is due to elevated insulin, not elevated blood glucose. That is, if you are maintaining your good BG numbers by running high insulin levels. This is one reason why I am taking an interest in Insulin Resistance at the moment.
 

I'd certainly agree that all that is really important is whether or not one experiences damage from having diabetes. So either fixing your insulin response, which some lucky (and determined) people have done, or working around a broken insulin response by not challenging it with carbs, are both great. But they are different things, and if both are classed as remission then communication becomes difficult. I'll have to accept that the medical community has a definition that I don't like, I'll get over it!

I also agree that even for the people whose metabolic system is restored to "normal", they will need to be careful of their diet in future. But is that exactly the same as "still being diabetic and managing it through diet"? Here's an interesting question in that regard: does someone who has fixed their metabolism need to watch their diet in order to avoid getting Type 2 (again) any more than someone born yesterday will need to watch their diet in order to avoid getting Type 2?
 

That's a nice way of framing it, I think. I sort of helps me deal with the terminology, even if I don't like it!
 
I agree with my gurus, Dr Bernstein and Jenny Ruhl, that the important question is not whether one is diabetic, or pre-diabetic, or no longer diabetic, but whether one's blood glucose levels are normal NOW (and yesterday and tomorrow), or as near normal as our food choices, exercise and medicine can make them. It is high blood glucose averages and spikes that causes heart attacks and all the dreaded complications of diabetes. Nothing else matters.
 

I like that and I like Jenny Ruhl and I think for most people most of the time, that's a great way to think of it.

I suspect it's not *always* true - some people will have complications that make glucose spikes a secondary concern.

You may be interested in this thread I started, I'd be interested if you would give your opinion on the article linked there. I did think of forwarding the link to Jenny Ruhl to see what she makes of it!

http://www.diabetes.co.uk/forum/threads/an-alternative-perspective-on-diabetes-management.130653/
 
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